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Health Systems Perspectives & Qualifications

McKinsey & Company: our
perspectives on achieving
impact in health system
reform


January
2009

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Health Systems Perspectives & Qualifications

1

Achieving impact in health systems reform


McKinsey’s health systems practice


Examples of our work



CONTENT

Appendix

Situation today

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HEALTHCARE REFORM IS A TOP ISSUE GLOBALLY

Improving healthcare is a top
public priority in every country . . .

. . . but where to start?

Health systems
are complex . . .


Difficult to determine what
to do


Quick wins are hard to
identify


Success is hard to measure

Rapid change is
difficult . . .


Many stakeholders, most
with different interests


Hard to rapidly increase
skills


Based on growth over the
past 40 years, projections
show health costs could hit
50% of GDP in more than
half of the OECD countries
by 2100

Funding is
limited and
costs are
already high

Percent per country ranking health
as the top personal concern*


*

Open
-
ended responses: "What is the most important problem facing you and your family today?" (multiple
answers accepted)


Source:


Kaiser Family Foundation and the Pew Global Attitudes Project released a report in Dec
2007

16
23
26
26
31
35
36
40
40
41
42
42
43
48
Britain

U.S.

Canada

France

Spain

Sweden

Japan

Italy

India

Germany

Bulgaria

China

Russia

Poland

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HEALTH CARE SYSTEMS LEADERS ARE UNDER PRESSURE TO TACKLE
MULTIPLE CHALLENGES

How to best balance

cost, quality, and access

in a manner that is both
sustainable and consistent

with social values and political
goals?


Improving value for spending


Ensuring rational adoption of
new drugs, devices, and
technologies


Creating value conscious
consumers and cost
competitive providers


Defining "right" level

of care and coverage


Defining role of private
and public sectors


Ensuring equity across
the system


Managing rising
numbers of chronic
disease patients


Reducing variations
in clinical practice


Adopting evidence
-
based care

Delivering high
quality

Providing
access

Responding to rising
costs

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AGING AND DISEASE MIX ARE DRIVING RISING COSTS GLOBALLY…

Note:


All WHO countries with private medical expenditures above USD 5 bn


*

Includes communicable, maternal, perinatal, and nutritional conditions

Source:

WHO Core Health Indicators, ICP Global Results, EIU, McKinsey analysis

10
%

60
%

30%

2000

21
%

59
%

20
%

2050


60

15
-

59

0
-

14

0

10
,
000

2
,
000

4
,
000

6,000

8
,
000

World population

Millions by age

Aging populations

33
32
30
25
21
9

58

50

1990

9

59

57

2002
*

9

61

58

2005
**

10

65

63

2015
**

10

69

73

2030
**

-
1.1

0.3

0.4

Commun
-
icable*

Chronic

Injuries

World deaths

Millions, percent

A shift towards chronic disease

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… AS IS INNOVATION IN TECHNOLOGY

All your

X
-
rays

a mouse click
away

“…and your
new arm will
be ready on
Friday”

“First marathon
in
1
:
35

with

Stryker knee”

50% of
diseases will
be predictable
at birth

1

2

3

4

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OECD
2005
2030
2050
2080
2100
OECD
2005
2030
2050
2080
2100
USA
15.3%
19.5%
23.7%
31.8%
38.7%
USA
15.3%
24.9%
36.7%
65.6%
96.8%
Switzerland
11.6%
14.8%
18.0%
24.1%
29.3%
Switzerland
11.6%
18.8%
27.8%
49.8%
73.4%
France
11.1%
14.2%
17.2%
23.1%
28.0%
France
11.1%
18.0%
26.6%
47.6%
70.2%
Germany
10.7%
13.7%
16.6%
22.2%
27.0%
Germany
10.7%
17.4%
25.6%
45.9%
67.7%
Belgium
10.3%
13.1%
16.0%
21.4%
26.0%
Belgium
10.3%
16.7%
24.7%
44.2%
65.2%
Austria
10.2%
13.0%
15.8%
21.2%
25.8%
Austria
10.2%
16.6%
24.4%
43.8%
64.5%
Portugal
10.2%
13.0%
15.8%
21.2%
25.8%
Portugal
10.2%
16.6%
24.4%
43.8%
64.5%
Greece
10.1%
12.9%
15.7%
21.0%
25.5%
Greece
10.1%
16.4%
24.2%
43.3%
63.9%
Canada
9.8%
12.5%
15.2%
20.4%
24.8%
Canada
9.8%
15.9%
23.5%
42.0%
62.0%
Australia
9.5%
12.1%
14.7%
19.7%
24.0%
Australia
9.5%
15.4%
22.8%
40.8%
60.1%
Iceland
9.5%
12.1%
14.7%
19.7%
24.0%
Iceland
9.5%
15.4%
22.8%
40.8%
60.1%
Netherlands
9.2%
11.7%
14.3%
19.1%
23.2%
Netherlands
9.2%
14.9%
22.0%
39.5%
58.2%
Denmark
9.1%
11.6%
14.1%
18.9%
23.0%
Denmark
9.1%
14.8%
21.8%
39.0%
57.6%
Norway
9.1%
11.6%
14.1%
18.9%
23.0%
Norway
9.1%
14.8%
21.8%
39.0%
57.6%
Sweden
9.1%
11.6%
14.1%
18.9%
23.0%
Sweden
9.1%
14.8%
21.8%
39.0%
57.6%
New Zealand
9.0%
11.5%
14.0%
18.7%
22.7%
New Zealand
9.0%
14.6%
21.6%
38.6%
56.9%
Italy
8.9%
11.4%
13.8%
18.5%
22.5%
Italy
8.9%
14.5%
21.3%
38.2%
56.3%
Luxembourg
8.3%
10.6%
12.9%
17.3%
21.0%
Luxembourg
8.3%
13.5%
19.9%
35.6%
52.5%
UK
8.3%
10.6%
12.9%
17.3%
21.0%
UK
8.3%
13.5%
19.9%
35.6%
52.5%
Spain
8.2%
10.5%
12.7%
17.0%
20.7%
Spain
8.2%
13.3%
19.6%
35.2%
51.9%
Hungary
8.1%
10.3%
12.6%
16.8%
20.5%
Hungary
8.1%
13.2%
19.4%
34.8%
51.2%
Japan
8.0%
10.2%
12.4%
16.6%
20.2%
Japan
8.0%
13.0%
19.2%
34.3%
50.6%
Turkey
7.6%
9.7%
11.8%
15.8%
19.2%
Turkey
7.6%
12.3%
18.2%
32.6%
48.1%
Finland
7.5%
9.6%
11.6%
15.6%
18.9%
Finland
7.5%
12.2%
18.0%
32.2%
47.4%
Ireland
7.5%
9.6%
11.6%
15.6%
18.9%
Ireland
7.5%
12.2%
18.0%
32.2%
47.4%
Czech Republic
7.2%
9.2%
11.2%
15.0%
18.2%
Czech Republic
7.2%
11.7%
17.3%
30.9%
45.5%
Slovak Republic
7.1%
9.1%
11.0%
14.8%
17.9%
Slovak Republic
7.1%
11.5%
17.0%
30.5%
44.9%
Mexico
6.4%
8.2%
9.9%
13.3%
16.2%
Mexico
6.4%
10.4%
15.3%
27.5%
40.5%
Poland
6.2%
7.9%
9.6%
12.9%
15.7%
Poland
6.2%
10.1%
14.9%
26.6%
39.2%
Korea
6.0%
7.7%
9.3%
12.5%
15.2%
Korea
6.0%
9.7%
14.4%
25.7%
38.0%
. . . WHICH COULD RESULT IN HEALTHCARE SPEND CONSUMING
DISPROPORTIONATE AMOUNTS OF GDP IF SYSTEMS GO UNCHANGED


Source:

Forecast model assuming real GDP growth of
2.0
%, health care spending growing at
0.95
/
1.9
percentage

points above; OECD Policy Implications of the New Economy
2000
-

2050
(
2001
);

Global Insight WMM
2000
-

2037

Half OECD
-
historic rate: GDP +
1.0

OECD
-
historic rate: GDP +
2.0

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7

Achieving impact in health systems reform


McKinsey’s health systems practice



Examples of our work



CONTENT

Appendix

Situation today

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Health systems reform is a
journey


Visionary leaders will experience
highs and lows but if thoughtful
of the overall direction, will
improve the health of the
population in a tangible and
measurable way, improve access
and manage costs

OUR BASIC BELIEF IS THAT HEALTH SYSTEMS REFORM IS A LONG
JOURNEY THAT REQUIRE VISIONARY LEADERS


There is no best system, adapting reform to
local context matters


Major transformation typically requires
2

5
years of sustained effort


Support from the top is crucial to ‘shape’ the
direction, it is imperative to understand the
full story


Success is driven by


Clarity of direction and what success will
look like relevant to existing context


Clarity on behaviours which need changing,
and how that will happen


The momentum generated by a few of
successful quick
-
win projects with
substantial quantifiable impact


Capability building at all levels of the
system, supported by significant leadership
inspiration and energy

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1

2

5

4

3

Focus change on
the target end
state

Take a holistic
view of the
health system

Develop
leadership at
every level

Follow the
patient’s journey

Use a multi
-
stakeholder
partnership to
drive change

Engage the system from within


All relevant
aspects of
government


Social and
private sector
actors


National public
health
outcomes


International
goals (e.g.,
MDGs*)


Patient
journeys
through the
health system


Key clinical
pathways


Top level
Ministry
leadership


Mid level system
leadership


Clinical
leadership


Governments


Donors and
bi/multi
-
laterals


Private sector


Social sector
and NGOs

Successful health system transformation


* Millennium Development Goals

ACHIEVING IMPACT REQUIRES ATTENTION TO A SET OF CORE
PRINCIPLES

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HEALTH SYSTEM REFORM REQUIRES CHANGING AN ENTIRE
SYSTEM, NOT JUST THE MINISTRY OF HEALTH

1

Ministry

of Education

(health care degree
programs, bursaries
and secondary
school sciences)

Ministry of
Finance

(health system
financing)

Regional and

local governments

(sanitation, hospitals,
schools and
infrastructure)

Ministry of Works

and Transport

(facility construction,
renovation and repair,

and roads)

Ministry of
Labour

(health care work
force


domestic
and international)

Parastatal

companies

(access to
telecommunications,
power, water for
health facilities)

Private Sector
(health care and
large employers)

Social Sector
(NGOs, community
service
organizations, think
tanks)

Ministry

of Health


Health systems
play a role in a
country’s human
and economic
development



While reform
may require
change at the
micro level, it will
also require
change at the
macro level
including many
other aspects of
government


Alternative/
traditional
medicine

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REFORM SHOULD FOCUS ON THE TARGET END STATE
WITH REGULAR TRACK OF PROGRESS

2


Reduce waiting time of
new patient referrals for
10
hospital specialties to
30
days or under


Begin operations by
7
:
45
AM for all departments

1

Outpatient
department

Waiting times

Improve
operation
theater
utilization


Days of waiting time for Gastroentology


Identification of
bottlenecks, such as
cold OT’s


Installment of timers
to heat OTs in the
morning


Reorganization of shifts

Objective

Progress against target

Target

GCC EXAMPLE

266

15

11

11

Oct
05

Jan
06

May
07

June 07


Optimized triaging by
nurse


Opening HC in the
evening


Pre
-
booking telephone
appointments


Patient segmentation



Main activities

2

March 06

Dec
06

May
07

8
:
06

9:33

8
:
32

Average opening times over a week,
gynecology services


Strengthen and enforce
quality standards in
private and public health
care


Strengthen the role of the
Office of Licensure and
Registration as regulator
of health institutions,
professionals and the
pharmaceutical industry

Establishment
of national
authority for
regulation of
health
profession and
services



Nomination and training of
CEO and key staff


Regulation of health
institutions, professionals
and the pharmaceutical
industry


Development, of national
minimum standards for
health institutions and
enforcement criteria


Establishment of criteria for
registration, licensing and re
-
licensing of health
professionals

3

2009

2007

2008

2006

System design

Start improving providers


Create regulator

Design of payor
and insurance
system

Pilot to improve primary care sustainability


Design of PC model

Design future hospital model


Performance improvement pilot

Diagnostic/inventory of current hospitals

Develop provider quality standards

Reorganise ministry, upgrade nursing curriculum, introduce doctor standards, launch leadership and business training for mini
str
y employees and hospital CEOs

Diagnostic

Idea creation and planning

6
-
monthly national health conferences

Primary care build
-
out/construction

Mobile clinics (clinical convoys)/ breast cancer screening

Plan and prepare for pilot of new health system in one region

Ambulance development

Dia
gno
stic

Design &
costing of
package

Organisational

design

Short
-
term, high

impact interventions

Primary care

reform



Activity

NHIS

Health system

structuring

Regulatory reform







Hospital reform

Regional pilot

Area

Policy/
strate
gy

1

Payor

2

Provid
er

3

Regul
ator

4

Cross
-
cuttin
g

5

Sequence of short
-
term highly visible healthcare
interventions to create
-
buy
-
in and sustain momentum

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1.
Women should be offered choice of home birth, midwife
-
led or obs
-
led care

2.
Obstetrics units with at least
96
hrs/week consultant cover

3.
Every obstetrics unit should have a co
-
located midwifery unit

4.
1
:
1
midwife
-
led care should be provided in labor within existing resources

5.
Antenatal and some postnatal care should be provided in local dedicated

hubs

Birth

Proposed key changes required to deliver world
-
class care based on best practice

Staying

healthy

1.
More should be invested in proven health improvement programs

2.
The NHS should play a greater role in improving the health of its employees

3.
All health professionals should be incented to improve health at each

interaction

4.
Need for more partnership working to help people stay healthy

LTC

1.
Integration of community and secondary care services

2.
Pro
-
active primary care to reduce emergency admissions

3.
Develop London
-
wide best practice Care Pathways for different LTCs
(e.g., DM, COPD, HTN, Asthma)

4.
Routine diagnostics provided in a community setting

1.
Improve access through local
24
/
7
urgent care centers with doctors on
-
site

2.
A single point of contact (by telephone) for urgent care

3.
Centralization and networks for Major trauma, MI, and Stroke

4.
Dispatch and retrieval protocols for LAS need to be aligned with centralization

Acute

Planned
care

1.
More specialized inpatient care should be centralized into major acute hospital

2.
Shift less complex surgery, diagnostics, and outpatients out of major acute

hospitals

3.
Better use of the day case setting for many procedures

4.
Improve community
-
based services (e.g., community nursing)

End of life

1.
Commission end
-
of
-
life service providers to co
-
ordinate end
-
of
-
life care

2.
People have an end
-
of
-
life care plan, including preferences on place of death

3.
All organizations should meet good practice (e.g., gold standards framework)

4.
Greater investment to support people to die at home

A CLINICAL PATHWAYS APPROACH IDENTIFIES
IMPROVEMENT AREAS ACROSS THE PATIENT’S LIFE SPAN

3

UK EXAMPLE


A clinical pathways
approach highlights
improvement areas
from a patient’s
perspective



Pathways highlight
opportunities for
change across different
care providers (i.e.,
primary, secondary,
tertiary, etc.)



The pathways
approach is useful for
engaging clinicians and
other health
practitioners in
identifying change
priorities

Observations / Rationale

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STRONG INDIVIDUAL AND COLLECTIVE LEADERSHIP IS
REQUIRED TO IMPLEMENT AND SUSTAIN CHANGE PRIORITIES

4


Today, many health interventions
can not be implemented or
brought to scale because of weak
system leadership, among other
factors


Strengthening leaders will
improve the effectiveness of
actors

within the public health
system


A collective leadership team


in a
coordinated fashion, with aligned
intent, focused on the most crucial
challenges in the system

will
achieve
step
-
change
improvements

in the health of the
system


Developing leaders in a complex
adaptive system such as public
health can
catalyze positive
increasing returns

and create
public health systems that evolve
organically to higher levels of
performance

Leadership development
can effect significant
lasting change

From…

To…


Developing people in
system


Shifting aspects of the system
while developing the people in it


Public healthcare
professionals


The individual


Inclusion of the private sector,
adjacent systems leaders (e.g.,
education, finance), others


Collective leadership team as
well


Technical/managerial
skills


Special project for
action learning


Mindsets (meaning, purpose,
etc.) as well as skills


Broader set of skills (e.g.,
interpersonal, etc.)


Joint initiatives to shift system at
leverage points


Injection of best
practice from outside


External faculty


Offsite program


Additive


Episodic


Engagement from within: enable
local capacity to develop, tailor,
embed, extend learning


Building on/removing barriers to
what works already

Necessary shifts in traditional leadership development
approaches

Objective

Target

Curriculum

Delivery
Mechanism

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5

REFORM SHOULD BE DRIVEN BY A MULTI
-
STAKEHOLDER
PARTNERSHIP

Reform will require commitment and resources from a wide group actors both public and
private over
3
to
5
years

Private sector

Deep functional expertise


Core competence in specific business areas, e.g.,
supply chain management, corporate finance, social
marketing

Broad
-
based business and organizational
experience


In
-
depth knowledge across multiple industries and
organizations

Specific product offering


Specific products and services required by the health
system, e.g., consumables and infrastructure

Donors and bi
-
/multi
-
laterals


Financial support


Ability to finance projects that support government
efforts as well as to test new approaches and initiatives

Broad health system experience


Experience across multiple geographies to share
knowledge and approaches

Deep knowledge in health


Depth in knowledge across health system financing,
human resources, infrastructure, operations, and
enablers such as IT

Government influence

Governments

Political influence


Power to mobilize political support,
to implement regulatory changes,
and to prioritize transformation

Robust support model


Access to sustained funding


Broad
-
based involvement

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15

Achieving impact in health systems reform


McKinsey’s health systems practice


Examples of our work



CONTENT

Appendix

Situation today

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Resources


Presence in
45
countries around the world with
89
offices


8 300
consultants around the world

Healthcare


2 250
projects since
2002


Clients include payors, providers, pharmaceutical
companies as well as medical products


Our consultants include over
150
medical doctors
and over
250
with Masters or Ph.D degrees in life
sciences, medical and healthcare fields

Origin

Founded in
1926
in New York by James O. McKinsey

Clients

Private sector
companies,
governments and
social sector
organizations

AN OVERVIEW OF MCKINSEY & COMPANY

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McKINSEY HAS ATTRACTED TALENT SPECIFICALLY TO MEET THE
GLOBAL HEALTHCARE SECTOR CLIENT NEEDS

The McKinsey Global Healthcare practice has medical, scientific
and extensive business management skills and knowledge

About
50
consultants with Master’s degrees in Healthcare
(e.g., Master of Public Health, Healthcare Management)

Approximately
150
MDs with patient care or research
experience (often both) representing most major medical
specialties including


Anesthesiology


Cardiology


Cardiovascular surgery


Gastroenterology


Critical Care and Emergency Medicine


Neurosurgery


Orthopedic
surgery


Pediatrics


Radiology

Approximately 200 consultants with Masters or doctoral
degrees in various life sciences and medical fields including


Genetics A


Immunology


Biochemical Engineering


Biotechnology


Molecular Biology


Neurobiology


Biochemistry


Pharmaceuticals

Source:


McKinsey & Company,
2007

100
% =

150

200

50

Consultants

Medical Doctors

Life Science

Masters/PhD

Other Health
-

related backgrounds

400

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Focus of this

document

McKinsey Healthcare Practice

Healthcare
Provision and
Payment

Pharmaceuticals
and Medical
Products

Health Systems

Global Public
Health


Governments


Governments,
hospitals


Foundations,
multilaterals, NGOs
(e.g., Gates Foun
-
dation, Global Fund,
GAVI, WHO)


20 of top the 20
pharma companies;
biotech and medical
devices

Clients

Focus


Expertise in running
developed health
systems, including
commissioning,
contracting and
community care


Expertise in
pharmaceutical and
medical products,
strategies, sales
and marketing,
R&D, operations,
etc.


Expertise in design of
MDG* programmes,
HIV/AIDS, vaccines,
evaluation and
strategies for
alliances


Expertise in
designing health
systems, including
assessing
performance, setting
strategic priorities,
policy and regulation

Geographies


Africa, India


Worldwide (mostly
developed
countries)


17
countries around
the world including
Egypt, Middle East,
Canada, Cyprus,
Namibia, India
Tanzania, and the UK


Major hubs in US,
U.K., Germany, and
Singapore


Work in more than

two dozen countries

HEALTH SYSTEMS IS ONE OF FOUR HEALTH CARE PRACTICES

AT MCKINSEY

* Millennium development goals

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Health systems
improvement
program design

Shaping the role
of the regulator

Healthcare
financing

Provider capacity
planning

Human resource
strengthening

Health
i
nformatics

Non
-
communicable
diseases

Access to care in
remote areas

OUR HEALTH SYSTEMS WORK IS TAILORED TO ADDRESS TYPICAL
ISSUES


We assist governments to perform a
diagnostic

to assess their health system
and

map
bottlenecks and
priorities

for health system reform


We help governments draw up a
vision

for their health system & identify
key reform elements


We work with
m
inisters of
f
inance and
h
ealth to optimize the way healthcare
funds are

collected,
administered and spent in line with
the

countr
y

s

priorities
, e.g. to
address shortages


We support key stakeholders to build capabilities throughout the healthcare pyramid
, e.g.
doctor education and continuous training, accreditation


We assist governments in assessing and transforming medical needs of whole
regions or
population segments into tangible infrastructure
, e.g.
physician allocation, emergency care


We help governments shape the role of the regulator and assist in building independent health
regulator
s

with a clear role and accountability
, eg.
quality regulator, reimbursement regulator


We work with governments in defining the IT
architecture that meets their needs for better
efficiency and information collection/transparency


We support governments to design chronic disease programs improving outcomes in
stroke,
cancer, diabetes, cardiovascular diseases as well as obesity


We support the set up and design of public private consortiums, building a

‘Mobile enabled'
infrastructure

that address the lack of healthcare resources in remote or rural areas

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Ministry restructuring, new
health insurance scheme

Patient safety in health
reform,
M
edicare for
elderly,
m
anaged care,
m
ammography
utilization

Provincial health policy,
demand & supply
management,
quality control

National review, c
apital accounting,
c
ompulsory medical audit,
c
ompetition as stimulus,
s
exual transmitted diseases,
f
ocus on publishing outcomes data,
n
ational screening
programs e
.
g
.

cancers,
w
aiting,
v
accination programs, H
R
multidis
ci
plinary teams

Sustainable
local care

User charges
,
emergency care,
rural care

System

reform

Stewardship
of

government/
governance

Task shifting,
standardizing
salaries of HC
workers

Movement to
national health
insurance

Focus on qua
-
lity accr
u
ed,
transfer of MOH
to NHA

Health system
blueprint,
provider
selection

Implement perform
-
ance management
program across
system

Regulati
on

of the
private sector

Decentralization of
health services/
regions and perform
-
ance based system

Data driven and
definition of ess
-
ential package

Health system
reform

Health insurance strategies,
integrated care

Health system diagnostic

Drug approval

Malaria prevention,
physician
education

System diagnosis,
initiative and leader
selection

Regional system
design

National insurance,
hospital/clinic coverage
and operations, quality
regulator

MCKINSEY HAS HAD THE OPPORTUNITY TO WORK ON HEALTH SYSTEMS
PROJECTS ACROSS THE WORLD

Policy framework
and implementation
roadmap

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Americas

EMEA

Asia

Paul van
Arkel

Russia


Viktor
Hediger

GCC/
HSIG
Practice
Leader


Claudia

Süssmuth
-

Dyckerhoff

China

Ludwig

Kanzler

Japan


Takashi

Takenoshita

Japan


Tilman

Ehrbeck

India

Deepak

Khandelwal

Canada

Axel Baur

Germany

Jean

Drouin

GPH/HSI
Leader

Nicolaus

Henke

EMEA HPP
Practice
Leader

Ben

Richardson

UK

Paolo

De Santis

Medeter
-
ranian

Thomas

London

France

David
Chinn

Israel

Shrey Viranna,

Sub Saharan

Africa

Paul
Mango

US

Maria
Marquez

Iberia

Chinta

Bhagat

Singapore

Yael Heynold

Australia/New
Zealand

Bruce
Simpson

Canada

Elisabeth
Hansson

Sweden

Amine
Omar Tazi
-
Riffi

North
Africa

A NETWORK OF PARTNERS WITH STRONG LOCAL AND GLOBAL
EXPERTISE

Carlos
Murietta

Latin
America

Cristian
Baeza

Latin
America

Rui Diniz

Iberia


Bob

Kocher

US

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McKINSEY REGULARLY PUBLISHES ON A RANGE OF HEALTHCARE
TOPICS, EXTERNALLY…


Addressing Japan’s Healthcare Cost
Challenge


A healthier healthcare system for the United
Kingdom


Innovation in Healthcare


an interview with
the CEO of Cleveland Clinic


A better hospital Experience


Mapping the market for medical travel


Dissecting global trends


an example from
Italy


Universal principles for healthcare reform

White papers

Health Europe/Health International


publications on the healthcare industry



Management matters


How service line management can improve
hospital performance


The health care century


The best that limited money can buy


Optimized procurement unlocks cash and
strategic options


Patient choice


threat or opportunity for UK
Hospitals


Quality of care


an international perspective for
the NHS


“Developing perspectives of high
-
impact
health systems reform”, McKinsey Global
Institute report


“Clinical leadership


unlocking high
performance in Healthcare” by James
Mountford and Caroline Webb



No holds barred in management battle, HSJ,
2008

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Achieving impact in health systems reform

Our experience


McKinsey’s health systems practice


CONTENTS

Appendix



Situation today and our perspectives

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Dr. Nicolaus Henke

Dr. Nicolaus Henke is a Director of McKinsey & Company, based in London. He has also served the Düsseldorf, Berlin, and New
York offices. He is Head of McKinsey’s Payor & Provider Healthcare Practice in Europe, the Middle East, and Africa and chairs

McKinsey’s work with national Health Systems globally. He frequently speaks at conferences and publishes on a broad range of
healthcare and talent management issues and is a lecturer in health system policy in various executive education programmes.


His recent experience includes:


UK health care management: Nicolaus is the overall head of McKinsey’s work with the NHS. Topics of his involvement include th
e
future of commissioning, the regulatory framework of the future health sector, the assessment and compliance approach of
Foundation Trusts, the diagnostic and capacity adjustment for Strategic Health Authorities, new models in emergency care,
designing payment by results, patient expectations under choice, the state of NHS finances and NHS financial management, and
governance in healthcare.

Global Health systems: Nicolaus has practical experience from 17 healthcare systems and is serving various governments and
heads of state on overall health system reform in countries as small as 600000 patients and as big as 70 million. He has work
ed
on a broad range of topics, such as health system funding and payment reform, designing and managing competing public
payors, cost and productivity programmes, hospital contracting, case management, pharmacy benefit design and management,
benefits management, and regional capacity planning.


Nicolaus was an Investment Adviser at Deutsche Bank AG for 2 years and graduated with distinction with a Master’s and Doctora
te
degree in Business from the University of Münster, Germany. He holds a Master’s in Public Administration from Harvard’s Kenne
dy
School of Government, where he was a John J. McCloy scholar.


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Dr. Axel Baur

Dr. Axel Baur is a Partner in the Düsseldorf Office of McKinsey & Company, Inc. and co
-
leader of both McKinsey's German
Pharma/Healthcare sector and the Middle East Healthcare Practice. Since joining the office in February 1996, he has served a
number of clients in various kinds of studies for different players in the healthcare industry, dealing with strategic, opera
tio
nal and
organizational problem solving issues.


Overview of recent studies:

Payor & Provider engagements in Europe


Development of a turnaround program and strategy work for a German insurance company. Based on a detailed analysis of the
financial situation, identifying a gap of Euro 100 million, a comprehensive program was defined addressing all levers within
pub
lic
insurance cost management.


Design of a hospital cost management program to manage 40% of a payor's expense. The program comprised
contracting/negotiating elements, authorization procedures as well as claims management algorithms. In a last step these
processes were imbedded in a new organizational structure

Payor & Provider engagements in the Middle East


Strategy for an integrated provider. Three entrepreneurs were supported in their endeavor to build an integrated service prov
ide
r
in Egypt, the Kingdom of Saudi Arabia and the UAE. The project included a business plan, the investor communication and the
overall financial plan


Strategy for a hospital group in Saudi Arabia. The project focused on the future development in the Kingdom and the expected
needs for tertiary care providers. The strategy depicted the required steps to be successful in the changing healthcare
environment


Healthcare system design for a GCC country. Following a holistic diagnosis of the country's healthcare system all key element
s
for the system were defined as well as the necessary migration path


Axel Baur holds a degree in Biology and a Ph.D in Molecular Biology from the University in Darmstadt. His research activities

focused on the molecular evolu¬tion/development of species. After his doctoral thesis he joined a biotech start
-
up, B•R•A•I•N. T
he
company's focus is scientific consulting and customer research, he holds the patent on genetically engineered mistletoe lecti
ne.

Before joining McKinsey he received an MBA from INSEAD, Fontainebleau.

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Dr. Viktor Hediger

Dr. Viktor is a Partner in McKinsey & Company's Dubai office. He is co
-
founder of and co
-
leading the global McKinsey Health
Systems Interest Group and is leader of the Middle East healthcare practice.

Viktor has a particular interest in health systems reform, holding an MD PhD MPH degree (MPH in Healthcare Management from
Harvard School of Public Health, 2001/2002), with his main focus being on Health system design and implementation and Global
Public Health.


His recent experiences include:

Health systems and Public Health

Strategic plan, health system design and implementation of the healthcare scheme in Cyprus

Strategic plan for a leading institution in the area of research for Tropical diseases

Health systems design and implementation support for two Gulf countries

Health strategy for a Gulf country with main focus on Tertiary Care

Health system diagnostic and Health system strategy for a developing country in West Africa

Global strategy for a top tier global non
-
profit organization

Strategy for Director General at WHO when taking office in 2003

Payor and Provider

Introduction of innovative and novel approaches for a Health Insurer in the field of customer segmentation to boost profitabi
lit
y
(Switzerland)

Development and implementation of a fully integrated care delivery system for a German Payor, including several hospitals and

their referring ambulatory physicians (Germany)


Viktor holds an MD degree (University of Berne, Switzerland, 1992
-
1998) with a PhD in Neurophysiology (1994
-
1998). Before
joining McKinsey in 1999, he has worked as a doctor in an orphanage for neurologically handicapped children in South America.

Trained a military doctor (First lieutenant) in the Swiss Army, Viktor is now acting as a communication trainer and coach/fac
ili
tator
for officers. At the age of 15
-
20 he was part of the Swiss National Judo Team.

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Dr. Jean Drouin

Jean Drouin is a partner in McKinsey and Company’s London Office. He has extensive international health care experience and
has worked in the US, Canada, Europe, Asia and Africa. Jean has served governments, hospital, pharmaceutical, and medical
device clients on a variety of strategic, operational and policy issues.


His experiences include:


Completing a capacity review of pediatric services in Ireland


Designing the regulatory strategy, including all aspects of assessment, monitoring and compliance, for a European health
regulator


Developing the implementation plans for major health policy reforms in the UK, including the introduction of DRGs for hospita
l
payment and the creation of a contestable market for hospital services


Assisting a major pharma player to design market access interventions that address the needs of non
-
physician stakeholders
across Europe


Evaluating future opportunities in the diabetes market and developing a product portfolio strategy for a global medical devic
es
company



Helping the Canadian affiliates of two global pharmaceutical companies merge and design a new organization and business plan


Conducting a cost/benefit analysis on the implementation of electronic physician order entry to reduce medical errors


Developing the go
-
to
-
market strategy and implementation plan to drive a 50% increase in patient volume at an academic heart
hospital


Assisting a 1,600 bed Korean academic medical center improve performance through length of stay reduction, increases in OR
efficiency and debottlenecking of radiology operations


Jean is a co
-
leader of the Health Systems Interest Group. His research interests include health system reform, financing and
regulation as well as clinical service configuration and pharmaceutical market access.

Prior to rejoining McKinsey, Jean was at Goldman Sachs International in London, where he worked in the Health Care and Biotec
h
Corporate Finance Group.

Jean received M.D. and MBA degrees from Stanford University. He holds a degree in Molecular Biology from Princeton Universit
y,
where he graduated Phi Beta Kappa. He also has a Certificate in Public and International Affairs from the Woodrow Wilson Sch
ool
.

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Dr. Paolo De Santis

Paolo De Santis is a Partner in the Rome Office of McKinsey & Company. Paolo main areas of competence are Public Sector,
with a strong focus on Health System, and Financial Institutions. In the Public Sector field Paolo has worked in three areas
i)
Productivity Enhancement with the Italian Government ii) Health System Reforms in Africa, Asia and Latin America iii) Regiona
l
Economic Development in Africa. In the financial sector Paolo has worked for major financial institutions (both Italian and
International), insurance companies and asset managers in a large number of areas both in retail and wholesale banking.


In the last 1,5 years Paolo has led the openings of the McKinsey office in Cairo where he has been working with the Egyptian
Government on a number of different topics. Among others: i) Country strategy for Foreign Direct Investment attraction ii) Fu
ll
development of a city of 600,000 people


Paolo De Santis entered McKinsey in 1998. Before that Paolo was assistant professor of Economics at the University of Viterbo

and taught economic dynamics at Luiss University in Rome and Macroeconomics and Microeconomics at Columbia University
(New York). Paolo has published several papers on macroeconomics and economic policy.


In 2002 and 2003 Paolo has been on a leave of absence working as the Head of staff of the deputy Minister of Economics and
Finance of the Republic of Italy leading several projects on matters included in the powers of the deputy minister. Among tho
se:

i) The privatization program of the national Postal and Railway operator ii) The Italian government procurement reform progra
m
(through Consip) iii) The rationalization of the IT systems of the Minister of Economics and Finance iv) The monitoring progr
am
of the cash flow of the whole Italian Public Administration through the creation of commonly adopted classification codes of
all

revenues and expenses.


During his period as a Treasury official Paolo served as a Board Member of SO.GE.I (IT company with about 500 mln euros of
turnover) and Quadrilatero (construction company with about 3 bln euros investment program)


Paolo holds a degree in Economics from Università La Sapienza, Rome and a Ph.D. in Economics from Columbia University,
New York.

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Dr. Cristian Baeza

Cristian Baeza is a Senior Expert in
Health Systems Policy, Financing, and Health Insurance

in
McKinsey & Company’s
Washington DC office, which he joined in 2008.
Cristian leads the Health System Financing Group at the firm and his recent
projects have included:



Leading work in regulation, health financing, and food regulation in GCC countries



Advising on the strategy development for a large international health foundation



Supporting work in health financing and health insurance in the Middle East and Latin America


Cristian has published articles on financing health systems, health and global development, including “Healthy Development:
The World Bank Strategy for Health, Nutrition and Population Results”. He is also a co
-
author of the book “Financing Health
Systems in the 21
st

Century” (OUP 2006) and “Health Systems: Improving Performance” (World Health Report, 2000, WHO).


Prior to McKinsey, Cristian was Director of Health, Nutrition and Population at the World Bank, a senior health systems and
health financing specialist at the International Labour Organisation and CEO of the Chilean National Health Insurance Fund,
FONASA. Cristian is a medical doctor with an MPH (Master of Public Health) from Johns Hopkins University and an MSc
(Master of Science) in Neurosciences from the University of Chile.

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Dr. Farhad Riahi

Dr. Farhad Riahi is a Partner in McKinsey and Company’s London office. He is a leader of our UK Healthcare Practice and of o
ur
Global Public Health Practice. He is also a practicing physician, and work with native communities in northern Canada.


Farhad leads our work on improving health outcomes and quality of care, and on improving the performance of complex
healthcare organisations. This includes:



Using evidence
-
based, cost
-
effective interventions to help payors improve the quality of care delivery (“Commissioning for
Quality”), particularly for chronic conditions


Designing payor strategies that bring together rigorous health needs analysis with private
-
sector approaches to prioritisation
and planning



Improving the performance of international health organisations (e.g., WHO, Stop TB Partnership) and of UK regional payors
through best
-
practice performance management and capability building


Strengthening medical education and training through changing structure, financing, and performance management of the
education and training process

,

Farhad serves clients at all levels of the UK health system, including hospitals (performance transformation of front
-
line clini
cal
services), regional payors, and the Department of Health. He also works with the World Health Organization and associated
global health partnerships. He has also served clients in France, Canada, and the Middle East.


Farhad holds an MD from McGill and an MBA from Wharton.

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Margareta Harrit

Margareta is the Practice Manager of the McKinsey Health Systems Group. Since joining the firm in 2004, Margareta has worked
on healthcare, global public health and pharmaceutical studies particularly in Europe, China and the US. Margareta’s work foc
use
s
on overall healthcare system diagnostic as well as the broad area of prevention, both of communicable and non communicable
diseases. Her recent experiences include:


Health Systems



Create, in collaboration with IASO*, a framework and tool for evidence based obesity prevention and reduction measures


Create framework to diagnose performance levers of a national health system


Develop tool to track health systems performance for regional decision makers through a clinical pathway approach


Design global workshop for Ministers of Health and private sector CEOs to share and build perspectives on public and private
collaboration in healthcare provision and financing in low, middle and high income countries


Pharmaceuticals and Global Public Health:


Margareta has been involved in numerous vaccines studies (product strategy, market access, licensing strategies, capacity
planning, pandemic planning) both from a profit and non profit perspective and co
-
authored articles on Avian Flu and Global
vaccine production


Strategy, capability building and organization


She spent 5 months with a pharmaceutical company focusing on CNS products leading a capability building programme for the
company’s market research division


Margareta also assisted a Belgian foundation develop their vision, mission and 2 year road map


Margareta holds an MA degree and a BSc from the Sorbonne University in Paris IV. Prior to joining McKinsey, Margareta

worked at the European Parliament and in a non profit organization facilitating content and best practice sharing on

Corporate Social Responsibility between member organizations and the European Institutions.

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Toby Lambert

Toby Lambert originally joined McKinsey & Company’s London office in 2002, and after two years in the Dubai office, is now an

Pr
actice Expert in London,
covering Health Systems and Health Systems Reform. Since joining the firm, he has worked primarily in the Healthcare sector.
Rec
ent projects have
included:


Planning, setting up & implementing a leadership academy to inculcate skills in a middle income country;


Planning the institution of a new national social health insurance system;


Implementing the pilot of a new social health insurance system in a middle income country;


Planning & implementing a new regulatory regime covering providers, professionals and pharmaceuticals;


Evaluating the impact, effectiveness and efficiency of a disease focused Global Public Health partnership;


Formulating the strategic plan and operating model for an integrated payor
-
provider in Latin America, including supporting on th
eir acquisition of another
similar integrated payor
-
provider;


Supporting the Department of Health in formulating their options as part of the wider regulatory review of health and social
car
e;


Assessing the Fitness for Purpose of primary care organisations across their risk of financial failure, governance, and their

ab
ility to commission care
effectively;


Diagnosing the issues facing a major Middle Eastern country’s healthcare system. Having formulated the main ethical, financia
l a
nd operational
challenges facing the country, work then moved on to setting the frame for addressing those problems through introducing a pu
bli
c health insurance
model and redefining the roles and responsibilities of all healthcare players in the country;


Developing the blueprint for the redesign of a Gulf country’s public healthcare system. Work included formulating the options

fo
r a health system along
the axes of access, financing, regulation and provision based upon international comparison, and then supporting the client i
n u
nderstanding the
ramifications of each potential choice of healthcare system and hence selecting their ideal model. Follow on work is focusing

on

transforming the
healthcare system to meet the blueprint;


Assessing the feasibility of a dedicated tertiary healthcare provider in a Gulf country. Work included assessing the required

ca
seload, the potential market
attractiveness of such a hospital and how it would complement the existing health facilities of the country


Formulating the strategic plan for a leading Middle East tertiary health care centre. Having conducted internal diagnostics o
n t
he hospital and an external
diagnostic on trends in healthcare in the country, the work then focussed on delivering operational improvements to support t
he
hospital in achieving its
strategic goals


Developing the regulatory mechanism for a UK governmental healthcare initiative, through defining the scope and strategy of a
n i
ndependent healthcare
regulator; and further assessing hospitals with a view to giving them authorisation under the new regulatory regime


Evaluating and supporting the M&A strategy of a US medical products producer. The work focussed initially on quantifying the
wor
ldwide market and
future growth rates for orthopaedic reconstructive products, identifying synergies with merger partner and formulating the fu
tur
e plan for the combined
entity. When acquisition turned contested, returned to evaluate potential responses to the other bidder

Prior to joining McKinsey, Toby worked with the National Health Service in the UK as a knowledge manager. Toby has obtained a
n M
Phil in Byzantine
Studies and a BA in Modern History from Oxford University.

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Deepak Khandelwal

Deepak Khandelwal is a Principal in the Toronto office of McKinsey & Company. He co
-
leads McKinsey's Canadian Healthcare
practice and is a leader of the Firm’s Operations practice. His client work focuses on strategy, operations, and organization

issues across a wide range of industries including customer care, healthcare, and retail.


Deepak’s recent study experience includes:



Improving patient access and flow (ED
-
GIM) at several Canadian hospitals and thereby increasing patient and staff
satisfaction


Determining the quantitative and qualitative benefits of IT investments in a healthcare region


Diagnosing and implementing solutions to increase CT/MRI throughput via operational process improvements


Improving the effectiveness of support functions in a North American hospital


Leveraging lean principles to improve the store operations of a retailer


Improving the process operations of a foodservices company


Developing the customer contact centre strategy for a healthcare company


Improving the financial performance of the customer service division of a North American financial institution


Developing and implementing a new business strategy and organization for a customer care service provider


Developing knowledge management and talent management strategies for a North American institution


Prior to joining McKinsey in 1994, Deepak worked with IBM and ran his own company, Deepak Enterprises. He earned a BSc in
electrical engineering from the University of Saskatchewan and an MBA from the University of Western Ontario. Deepak is
married to a gastroenterologist and has two kids.

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Dr. Tilman Ehrbeck

Tilman is a partner in our Global Healthcare Payor and Provider Practice. He joined McKinsey in 1996 and has been based in
New Delhi since 2005.


Tilman has served for
-
profit and non
-
profit health care providers and insurance companies on issue of growth, organization,
business performance and service operations in North America and more recently India.


Before moving to India, Tilman led McKinsey’s proprietary consumer research on opportunities and challenges associated with
the rise of consumer
-
directed health plans in the U.S.


Tilman is a German national. He holds a Ph.D. in economics and a B.A. in business administration.